Provider Demographics
NPI:1881791465
Name:LEPORE, RICHARD DAVID (MFT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DAVID
Last Name:LEPORE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 WESTMOUNT DR APT 211
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5173
Mailing Address - Country:US
Mailing Address - Phone:323-243-9977
Mailing Address - Fax:310-499-5610
Practice Address - Street 1:9021 MELROSE AVE STE 201A
Practice Address - Street 2:WEST HOLLYWOOD
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-5691
Practice Address - Country:US
Practice Address - Phone:310-499-5610
Practice Address - Fax:310-499-5610
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist